UCSD launches major study of parkinson’s

Aim is to identify early symptoms, better understand neurodegenerative disease

The first and most common sign of Parkinson’s disease — the second most common neurodegenerative disorder after Alzheimer’s — is trembling of a hand, foot, arm or leg, a shaking that progressively worsens.

Over time, other symptoms can appear: slowed movement, stooped posture, a shuffling gait. Changes in personality, depression, dementia, insomnia and speech impairments may also occur. Each year, more than 50,000 new cases of Parkinson’s are reported in the United States. Roughly 500,000 Americans have the disease, whose cause or causes are not known.

There is no cure, but there are serious efforts under way to better understand how the disease occurs and how to remedy it. Last year, scientists at the University of California San Diego School of Medicine helped launch a landmark five-year, $45 million international observational clinical study called the Parkinson’s Progression Markers Initiative, funded in part by the Michael J. Fox Foundation for Parkinson’s Research, to identify biomarkers (early indicators) of the condition before disease symptoms become obvious. The study continues to seek participants, both persons with newly diagnosed Parkinson’s and “controls” who do not have the disease. For more information, visit
adrc.ucsd.edu/enroll.html#PPMI.

Also, the UC San Diego Parkinson’s Disease Research Consortium is again hosting free memory screenings at the Shiley-Marcos Alzheimer’s Disease Research Center in La Jolla for at-risk people, age 65 and older. The 20-minute screenings will be offered Feb. 7 from 9 a.m. to 4 p.m. An appointment is required. Call (858) 822-4800.

We contacted Dr. Douglas Galasko, a professor in the UCSD Department of Neurosciences and a principal investigator of the PPMI, for a research status report and advice about treating the disease.

Q: Parkinson’s appears to be a disease of older age, with the average onset around 60 years. Occasionally, though, the condition emerges much earlier, as in the high-profile case of Michael J. Fox. What does that tell you about its cause or causes. Could it be triggered earlier by environmental factors or the particular genetics of a person? Any clues as to what those triggers might be?

A: Genetic underpinnings for Parkinson’s disease are increasingly being recognized. There are now 10 genes where alterations in the DNA (mutations) can lead to Parkinson’s, often with an earlier-than-usual age of onset. In addition, recently developed techniques for analyzing variations across people’s entire DNA coding (called genome-wide studies) have suggested that there may be other genetic changes that act as risk factors. The environment is much harder to pin down than DNA. Questions persist about whether certain types of pesticides and industrial chemicals may contribute to Parkinson’s, but people’s exposure is difficult to measure rigorously. Most likely the interplay between genes, environment and brain aging modify whether someone may develop Parkinson’s.

Q: What’s happening with the PPMI study? Why is it important to identify biomarkers for Parkinson’s?

A: We are learning more about how established markers, such as dopamine transmitter scanning (a brain-imaging study that measures the strength of biochemical connections responsible for movement), change very early in the disease. To date, almost 300 people have been enrolled worldwide, and we are hoping to identify new markers using MRI, blood and cerebrospinal fluid tests to help to track changes in Parkinson’s that may help to provide a sensitive readout of how novel treatments are working.

Q: Currently there is no cure for Parkinson’s. Can its progression be slowed? There was a recent study that suggested activities as simple as playing bingo may boost thinking and playing skills for people with cognitive difficulties and visual perception problems caused by neurodegenerative conditions like Parkinson’s.

A: Current treatment can help with many of the movement problems associated with Parkinson’s disease. Problems in thinking, affecting memory and other cognitive abilities are increasingly recognized as part of the progression of Parkinson’s. In a substantial number of people, they can impair functional abilities and quality of life. Brain stimulation through cognitive training — for example, playing games of skill or using computer programs — has been studied as a remedy for memory problems.

Unfortunately there are no easy fixes: Repeated practice makes people better at that particular skill or game. It does not carry over to benefit other brain skills, and does not slow progression of disorders like Alzheimer’s or Parkinson’s.